Insurance Coverage

 

Insurance Coverage for Breast Reconstruction

 

In almost all cases, if your insurance plan provides coverage for the cost of a mastectomy it must also, according to Federal law, provide coverage for the method of breast reconstruction you wish to undergo; this coverage includes perforator flaps such as the DIEP, GAP and PAP flaps. This law applies both to reconstruction done at the same time as a mastectomy, and also to reconstruction done at a later date. If a surgeon in your network of participating providers does not offer the method of reconstruction you prefer, your insurer must still provide coverage, even if this means covering the cost of surgery with a “non-participating” physician.

 

We are continually trying to work with other insurers to increase the number of network in which we participate. If you are insured by a plan with which we do not participate, please know that our staff is very experienced in working with insurers to help you obtain coverage for breast reconstruction procedures, and we will be happy to answer questions you may have.

 

Regularly, we are able to obtain authorization for women who do not have access to “in-network” physicians offering perforator flap breast reconstruction to go out of their networks to have their surgery. We are often able to arrange for coverage, on an individual basis, for women with HMO plans, patients with self-funded ERISA plans, people who have previously been denied coverage for breast reconstruction surgery and for women with unsatisfactory outcomes from prior reconstruction. In all cases, we will work closely with you and your insurance carrier to minimize any out-of-pocket expenses.

We are in-network with a select number of insurance carriers.

 

For more information, please contact our office at 404-480-4888.

 

Overview of Federal Law pertaining to Breast Reconstruction

 

The Women's Health and Cancer Rights Act (WHCRA) of 1998 contains important protections for women who wish to have breast reconstruction after mastectomy. This law requires group health plans and individual health policies that provide coverage for mastectomies to also provide coverage for breast reconstruction.

In accordance with the WHCRA, members of group health plans receiving mastectomy-related services are entitled to:

  • Reconstruction of the breast on which the mastectomy has been performed

  • Surgery on the opposite breast to produce a symmetrical appearance (including reduction, breast lift or augmentation)

  • Treatment of physical complications at all stages of the mastectomy, including lymphedema

 

Additional information is available from the US Department of Labor, which has oversight of the WHCRA.

A PRACTICE DEDICATED TO BREAST RECONSTRUCTION

DIEP . SIEA . Stacked DIEP . PAP . DIEP-DCIA . TUG . S-GAP

 

 

ATL DIEP

 

Dr. Theresa Wang and Dr. Samuel Shih are amongst only a handful of surgeons in Georgia that routinely utilize the DIEP and SIEA flaps in breast reconstruction. These techniques utilize the patients’ own abdominal skin and fat to recreate the breasts while sparing the abdominal muscles.

 

DIEP FLAP

 

The DIEP flap is the latest modification of the traditional pedicled TRAM procedure. The TRAM was pioneered by Dr. Carl Hartrampf in 1981 and actually originated in Atlanta, Georgia. Since then, there have been several modifications such as free TRAM and muscle sparing TRAM. These modifications have resulted in a flap with a more robust blood supply and less abdominal wall morbidity.

 

The DIEP flap is a free flap where the abdominal muscles are preserved. Only the skin and fat is utilized in the breast reconstruction thus causing even less abdominal wall morbidity.

 

The skin and fat is removed from the abdomen via a tummy tuck incision while keeping the blood supply attached via the Deep Inferior Epigastric Vessels. The skin/fat flap is then transplanted to the chest where it is connected to blood vessels using a microscope. The skin and fat is then molded into the shape of a breast.

 

STACKED DIEP

 

The Stacked DIEP Flap is where both sides of the abdomen (two DIEP flaps) are used to reconstruct one breast. It is an option for unilateral breast reconstruction in woman who do not have sufficient fatty tissue for a single DIEP flap breast reconstruction.

 

This technique provides the opportunity for woman, who usually are not candidates for abdominally based breast reconstruction, to receive DIEP flap reconstruction.

 

Dr. Theresa Wang and Dr. Samuel Shih are amongst the most experienced in Georgia in Stacked DIEP Flap breast reconstruction. This allows women with insufficient fatty tissue, who need reconstruction of only one breast, the option of DIEP flap reconstruction. 

 

SIEA FLAP

 

The SIEA flap does not violate the abdominal fascia or muscle at all. It is essentially a tummy tuck, with preservation of the blood supply to the abdominal skin and fat. The blood supply, Superficial Inferior Epigastric Artery, does not run through the abdominal musculature like the DIEP flap and therefore no violation of the abdominal fascia and muscle is needed at all. While this would make this the ideal flap, the SIEA is frequently too small to provide robust bloody supply to the flap. Given the potential benefits, the SIEA and SIEV is dissected out and examined in every patient undergoing abdominally based free flap reconstruction of the breasts. The SIEA flap will be offered to our patients based on our intra-operative findings.

 

EXTENSION FLAPS – DIEP-DCIA

 

There are women who require a little more fatty tissue, that cannot be provided by DIEP flaps alone, to achieve their desired size.  These women may have the option of a DIEP flap with DCIA extension. This is where the DIEP flap is extended to another zone supplied by the Deep Circumflex Iliac Artery. This adds an additional microvascular connection thus allowing for more blood flow to the larger flap.

 

 

Abdominally based free flap breast reconstruction is dependent on the availability of skin and fat from the abdomen.  Some woman are not candidates given their prior surgical history such previous abdominoplasty “tummy tuck” or major abdominal surgery. Others, simply do not have enough fatty tissue to reconstruct the breast.

There are other donor sites that can be considered for some patients:

 

 

BRCA Reconstruction

 

What do we know about heredity and breast cancer?

 

Each year, approximately 200,000 women in the United States are diagnosed with breast cancer, and one in nine American women will develop breast cancer in her lifetime. However, hereditary breast cancer — caused by a mutant gene passed from parents to their children — is rare. Estimates of the incidence of hereditary breast cancer range from between 5 to 10 percent to as many as 27 percent of all breast cancers.

 

In 1994, the first gene associated with breast cancer — BRCA1 (for BReast CAncer1) was identified on chromosome 17. A year later, a second gene associated with breast cancer — BRCA2 — was discovered on chromosome 13. When individuals carry a mutated form of either BRCA1 or BRCA2, they have an increased risk of developing breast or ovarian cancer at some point in their lives. Children of parents with a BRCA1 or BRCA2 mutation have a 50 percent chance of inheriting the gene mutation.  If a patient carries BRCA gene, they can have a lifetime risk of 50-70% of developing breast cancer.

 

BRCA Reconstruction

 

In the event you are diagnosed with a BRCA1 or BRCA2 mutation and have been referred for prophylactic, or risk-reducing  mastectomies, you have several options in breast reconstruction:

-DIEP flap reconstruction

-Direct to implant reconstruction

-Implant-based reconstruction with tissue expanders

 

© 2014 ATL DIEP

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